If you are currently battling a serious health issue, or if you have recently undergone medical treatment, the last thing you want to do is fight your health insurance company over your health insurance claim. Unfortunately, health insurance companies do not take into consideration your state of mind or well-being, and will deny a claim oftentimes without reason. When your claim is denied, The Bennett Law Firm will help you appeal the insurance company’s decision and ensure that you are reimbursed for your medical expenses.
Reasons Your Claim May Have Been Denied
In order to successfully appeal a health insurance company’s denial it is first important to understand why your claim was denied. Your insurance company should have listed the reason for denying you your settlement on your denial letter. Typically, an insurance company will deny a health insurance claim for one of the following reasons:
- Incorrect Patient Identifier Information: If important information such as your name, social security number, or date of birth is wrong, the insurance company cannot identify you as the patient, and therefore, cannot pay you.
- Terminated Coverage: Oftentimes, policyholders will let their insurance coverage lapse without even realizing it. If your claim has been denied, double check to make sure that you are current on all payments.
- Services Are Excluded: Another common reason for denial is simply because your insurance policy does not cover the services or treatment you filed for.
- Request For Medical Records: Sometimes an insurance company won’t deny you your claim; they’ll simply send a request for more information. Oftentimes, the health insurance provider wants to see a proof of your treatment and condition, so they will request a copy of your medical records.
- Bill Liability Carrier: Sometimes a health insurance company will refuse to pay out your claim because they believe that a different carrier should handle it. For instance, if you were injured at work but filed a health insurance claim with your health insurance provider, they may request that you go through your employer’s workers’ compensation provider.
- Missing or Invalid Codes: If your medical coder is not up-to-date on the most recent changes to the health care coding system, they may unwittingly mess up your claim.
It is important that you review the denial letter as well as your health insurance policy before getting too worked up. Many times, a denial simply occurs because of an error in filing, in which case, your Oklahoma insurance attorney can help you file an appeal with the correct information.
Appealing the Decision
The Bennett Law Firm has extensive experience in helping clients obtain a reversal of their health insurance carrier’s initial denial. When dealing with a denied health insurance claim, there is one of two ways that you can go about it:
- Internal Appeal: With an internal appeal, you will appeal directly to the health insurance provider. You will simply ask your insurance company to conduct a full and fair review of its decision and to overturn their decision if they were, in fact, unfair in their initial decision.
- External Review: If your insurance company will not conduct an internal review, you may have to appeal to an independent third party. Typically, this is where an attorney comes in. When an external review is started, the insurance company no longer has any say in whether or not to pay your claim.
Whether you open an internal appeal or an external review, the lawyers at The Bennett Law Firm understand what it takes to obtain a reversed decision, and will do everything necessary to help you obtain the compensation you need to cover your medical expenses. Oftentimes, this entails reviewing the denial letter and your insurance policy, gathering evidence to show that the medical services you want covered are medically necessary, and making sure that all paperwork is filed accurately and on time.
Working with a lawyer experienced in claim denials can significantly help you out, as a lawyer will deal with the paperwork, negotiations and insurance company representatives while you focus on your health concerns.
Consult an Oklahoma Insurance Claims Denial Attorney
The Bennett Law Firm understand how devastating it can be to be denied the coverage you need to get whole and healthy again. They use their extensive knowledge of healthcare law to appeal the insurance company’s decision and obtain a successful outcome. If you have recently been denied the coverage you need and have been paying for, reach out to the attorneys at The Bennett Law Firm. Call their office at 405-272-0303, or contact them online, to schedule your free consultation today.